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When activated, the mast cells in the skin release mediators (histamines, tryptase, TNF-alpha, CXCL9, etc.) that cause inflammation, flushing, itching, or burning.[ref] Related article: Rosacea, underlying causes, genetic susceptibility Dermatographism and mast cell activation syndrome: In a survey of mast cell activation syndrome, dermatographism was found in 89% of the patients.[ref] Dermatographism is when you get welts or raised red lines when you scratch your skin lightly

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Cover the skin as desired with a thin layer 1 to 3 times daily

Keep the pen cap on when not in use to protect from light and reduce contamination risk of the needle attachment site